Ground Rules for the Single Payer Debate in Vermont

The national debate about health reform has been dominated by sloganeering. Polling suggests that the public does not understand the drivers of health care costs or the amount of redundancy, waste and harm in the system. The Obama administration has concluded that it should have done more to educate the public and shape the debate.

The states are the key laboratory for health reform now. I've written about how Vermont is giving serious attention to a single payer proposal (see here). Nationally, that concept has been largely off the table, shot down by slogans about "socialized medicine" and "government takeover of health care."

I was happy to see an editorial in the Burlington Free Press suggesting ground rules for how political debate should proceed (for overseas readers - Burlington, with a population of 40,000, is the largest city in a small state). Here are the key passages:

The most important task before advocates of health care reform is to explain the proposals put forward by the state consultant in a way that ensures the debate remains focused on the facts...Vermonters deserve an informed discussion about the future of health care in our state. As those who pushed through national health care reform discovered, how the Shumlin administration and lawmakers explain the plan will be as important as what is in the plan.

On one extreme are the many people suspicious of an expanded role for government in their lives and have little faith that government can do things better. On the other are those who feel that everyone has a right to adequate health care and that can only be achieved under a government-run system.

There is nothing constructive in an exchange of heated rhetoric designed to stoke fear or that attempts to demonize the other side. There is no point in coming to a conclusion before all sides fully digest the proposed changes and explore the issues.

The drive toward single-payer health care system for the state is, perhaps, the most ambitious and among the most controversial item on Shumlin's agenda. Understanding the proposals and how they will affect Vermonters is the first step to any meaningful discussion. The matter is too important to be left to nasty sound bites and empty slogans that bear little resemblance to the issues on the table.

Newly elected Governor Shumlin is the crucial player in determining whether a serious innovative proposal is given thoughtful attention and a fair chance at being implemented and tested in action. At 620,000, Vermont is approximately 1/500th of the U.S. population. If the state can apply the thoughtful process the Burlington Free Press suggests, it will be doing a disproportionately important job for the entire country!